A Manhattan company that has previously signed up customers to receive monthly shipments of drugs to treat hair loss and migraines is moving into acid reflux.

Thirty Madison is introducing Evens, a service for patients with acid reflux which will allow them to receive free deliveries of generic versions of treatments such as prescription Nexium and over-the-counter Tums. Users are able to track their symptoms and book telehealth visits with gastroenterological specialists. Those specialists are then available to answer lingering questions.

Thirty Madison has about 50 employees in Manhattan and has raised about $23 million in venture capital funding.

Direct to consumer health care companies have attracted hundreds of millions of dollars to compete with chain drug stores for customers' dollars. The companies include Thirty Madison's Keeps for men's hair loss and Cove for migraines as well as Ro which offers treatments for erectile dysfunction, hair loss, STDs and smoking cessation. Hims and Hers sell drugs for erectile dysfunction, hair loss, STDs, birth control and skin care.

The space is competitive. Zachariah Reitano, CEO of Ro, mocked rival Hims on Monday for copying the design of its digital doctor visit in a post on Medium.

The companies offer the convenience of skipping trips to the drug store for medications and potentially eliminate doctor visits for conditions people might not be eager to discuss openly.

Bunny Ellerin, director of the healthcare and pharmaceutical management program at Columbia Business School, said she has noticed the proliferation of direct-to-consumer companies focused on managing individual conditions. She said she is curious how these companies would compete with online pharmacies such as Amazon's PillPack and Capsule.

"This is sort of like a micro bit of disease management but I guess more convenient," Ellerin said. "I'm just not sure what the problem is that they're solving."

Thirty Madison CEO Steven Gutentag said people often deal with acid reflux but don't make the effort to address it.

The company provides information about different types of acid reflux drugs to help customers determine what they might need. Its pricing is comparable to major drug stores. Evens charges $5 for a month's worth of antacids while CVS' brand of antacid tablets sells for $6.29. A six-month supply of omeprazole, the generic version of Prilosec, sells for $21 versus $23.79 at CVS. Coupons and sales at the drug store can drive the price lower.

Shipping and handling costs $3 at Evens and orders arrive five to seven business days after users approve their treatment plans.

Evens doesn't accept insurance but says its prices are comparable to what some patients would owe in copays.

"When you cut out a lot of middlemen you're able to provide affordable pricing," Gutentag said.

Telehealth consultations cost $30 and include free follow-up chats with the physician for a year. If a doctor determines that a patient doesn't need the medications Evens sells, the customer gets the $30 back.

The company doesn't want to disrupt patients' relationships with their primary care doctors, Gutentag said, but offers an option for those who might be faced with waiting a month or more to see a specialist.

"We think of ourselves, not as a replacement for the primary care experience but as helping to expand access to specialist treatment and ongoing care for these chronic health issues," he said." —Jonathan LaMantia

National report recommends more access to opioid treatment

State policymakers should work to remove barriers to getting treatment for opioid-use disorders so that more users can get into recovery and reduce overdose deaths, according to a new report from the American Medical Association and Manatt Health.

The national report examined strategies used in Colorado, Mississippi, North Carolina and Pennsylvania to fight the opioid crisis. It recommends states provide access to evidence-based treatment, enforce parity laws that require equal coverage for behavioral health conditions, ensure adequate insurance networks and improve access to alternative pain management and the overdose prevention drug naloxone.

One of the recommended strategies, prohibiting insurers from requiring prior authorization before doctors can prescribe drugs which reduce opioid cravings, is currently under consideration in New York. The state Legislature passed bills this year that would allow Medicaid beneficiaries and people in state-regulated commercial insurance plans to access all types of medications to treat opioid addiction without prior authorization.

Those bills are now awaiting Gov. Andrew Cuomo's signature.

New York is receiving $92.9 million over two years from the federal government as part of the State Opioid Response Program.

Dr. Susan Kansagra, chronic disease and injury section chief at the North Carolina Department of Health and Human Services, said grant funding won't be adequate to address the long-term needs of people recovering from using opioids and a more sustainable funding model must be established.

"We would never treat high blood pressure with grant funding," Kansagra, who contributed to the report, said. "These are conditions that require a lifetime of treatment and support." —J.L.

Manhattan fertility company expands services after raising $15M

Manhattan-based Extend Fertility is growing its roster of services following a $15 million Series A investment earlier this year by private equity firm Regal Healthcare Capital Partners.

With a model to offer fertility services at lower cost, Extend Fertility—which initially froze eggs exclusively—is now offering a full range of in vitro fertilization, infertility treatments and embryo freezing. The company, founded in 2016, announced that customers who have already frozen their eggs with it will receive a 25% discount on IVF services.

"We found that the same differentiators that made Extend Fertility a leader in egg freezing were valuable to patients struggling with infertility," said CEO Anne Hogarty in a statement. Hogarty joined the company earlier this year. She most recently served as chief business officer at Prelude Fertility and president of MyEggBank, and previously held several executive-level positions at the media company BuzzFeed.

Extend Fertility's recent expansion into IVF and other offerings comes at a time when the average cost for fertility treatments can run tens of thousands of dollars and the state is looking for ways to improve access to fertility services.

The company's lower-cost model is driven by efficiency, such as ordering only necessary tests, Dr. Joshua Klein, co-founder and chief clinical officer, recently told Crain's. It also aims to make up for low margins with high volume, he said.

Aside from adding offerings, Extend expects to double the size of its clinic near Columbus Circle by the end of 2019.

The company completed over 1,000 cycles of egg freezing last year. It does not disclose revenue. —Jennifer Henderson

H+H, Queens borough president partner on overdose training

New York City Health + Hospitals, the city Health Department and Queens Borough President Melinda Katz have partnered to provide opioid-overdose training this week to members of the public.

The free training, at H+H/Elmhurst, is designed to instruct family, friends and bystanders on how to save the lives of people suffering from overdoses. Specifically, it will cover how to identify the signs of an opioid overdose and administer the overdose-reversal drug naloxone. Kits containing naloxone will also be distributed to anyone at least 12 years of age.

"Giving the general public free training on how to use naloxone can empower Queens residents to save lives and prevent further overdose deaths," said Israel Rocha, CEO of H+H/Elmhurst and vice president of the health system, in a statement.

Though Queens recently saw a reduction in overdose deaths from 270 in 2017 to 215 in 2018, the number of overdose deaths remains high citywide, Katz's office said. Last year 1,444 people died due to unintentional drug overdoses, according to the city's health department.

On a larger scale, H+H plans to offer opioid-overdose training at all 11 of its hospitals by the end of the year. About 20,000 of the health system's patients suffer from opioid-use disorder and some 14,000 of those patients visit its emergency departments each year.

Naloxone is a safe medication often carried by nurses and first responders. On Friday, the state's Department of Financial Services issued guidance to health and life insurers stating their obligation to provide insurance to nurses and first responders who carry the medication to reduce overdose deaths. —J.H.

AT A GLANCE

VAPING: Gov. Andrew Cuomo said Monday the state would subpoena manufacturers of additives that are used in illegal marijuana vaping products after 41 people in New York were diagnosed with respiratory illnesses linked to vaping. The state is exploring requiring retailers to post signs saying, "Vaping can expose you to toxic chemicals and kill you." Health Commissioner Dr. Howard Zucker noted that the dangerous additive has not been found only in black-market products, not commercial ones.

HALL OF FAME: Northwell Health CEO Michael Dowling was inducted into Crain's Hall of Fame, which honors leaders who have left a lasting mark on New York business. He told Crain's Greg David that Northwell's decision to move into Manhattan has proven a success. "Everyone told me it was a bridge too far and the competitors would eat our lunch. They have not. We have 86 locations in Manhattan today, and we have patients coming to us and doctors coming to us rather than going to other places," Dowling said.

WHO'S NEWS: Ophelia Byers is the new chief nursing officer at New York–Presbyterian Hudson Valley Hospital in Cortlandt Manor. Byers, a nurse practitioner, was previously director of nursing at New York–Presbyterian Lawrence Hospital in Bronxville. Byers joined the health system in 2012 and earlier in her career spent eight years in the U.S. Army Reserves as a chemical operations specialist.

TOBACCO REMOVAL: Larry Merlo, president and CEO of CVS Health, explained why removing tobacco from all its stores was the right move for the company, regardless of the bottom line, in an opinion piece for CNN.

DIABETES: Health experts say Medicare's coverage of personal nutritional counseling for people with diabetes or chronic kidney disease is underutilized and could help more people manage their health, Kaiser Health News reported.

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